Circular Resection Research Articles

Acquired benign esophago-airway fistulas.

Over a period of 25 years, 35 patients with acquired benign esophago-airway fistulas were treated. Only two of them were female. The etiology of the communications was corrosive burns, penetrating wounds, postoperative and endoscopic lesions, esophageal diverticula, prolonged ventilatory assistance, pleural empyema and foreign bodies. Radical operative treatment was performed in 31 cases. In four of these the procedure was palliative, because of poor general condition and lung complications. The operative approach was chosen after precise endoscopic and contrast X-ray examinations. A cervical approach with partial median sternotomy to the third intercostal space was performed in 19 patients. In the rest of the patients a thoracotomy was performed. Simple excision of the fistula, longitudinal suture of the trachea and horizontal suture of the esophagus was the method of choice in nine patients. A flap from the left sternocleidomastoid was additionally interposed in front of the esophagus in 12 patients. In six cases circular resection, reconstruction of the trachea and plastic suture of the esophagus were performed. Esophagectomy with ensuing colon substitution was necessary in four patients. Excellent or good results were obtained in 29 of the 31 patients operated on. We had two deaths in the early postoperative period (6.8%) due to lung complications in patients with chemical burns of the esophagus. The operated patients were followed up for period ranging from 3 to 20 years. Acquired esophago-respiratory fistulas require emergency surgical treatment. The proper choice of operative approach is largely dependent on the precise diagnosis. Preoperative intensive care and metabolic balance are important factors in this report. Radical operative treatment depends on the basic disease, local inflammation and lung complications.

Die Heermann-Modifikation der intranasalen Mikrochirurgie bei Tränenwegstenosen*, **

The authors demonstrated Heermann's modification of intranasal microsurgery on the tearways. Since 1912 all intranasal lacrimal sac operations at the Krupp Hospital (up to 98 cases yearly) have been performed according to Randolph and West (1909). During the last 36 years our patients have been operated on in a semisitting-(Fowlers)-position with the help of the binocular microscope and with hypotensive anaesthesia. This technique of lacrimal sac surgery is demonstrated "step-by-step" with the removal of the medial wall of the lacrimal sac in abscesses or dacryoliths. In rare cases of a presaccal stenosis, a circular resection of the stenosis after J. Heermann (1989/1991) was done to leave the common duct open by the retraction of the scar. That is the reason why the insertion of plastic prostheses is rarely necessary (only in patients with congenital aplasia or extensive stenosis of the horizontal lacrimal duct). Funnel-shaped prostheses of glass were developed in 1925 by J. Heermann sen., of steel 1930 by H. Heermann and made by plastic material 1966 by J. Heermann. During a ten-year period (1976-1986) we evaluated 659 cases of intranasal microsurgery on the tearways. The use of plastic prosthesis was necessary in 17 cases. Including reoperations (first operation after Toti) satisfactory results were obtained in 94% of all cases.

A CLINICAL STUDY OF DIFFERENTIATED THYROID CARCINOMA RESECTED WITH THE LARYNX AND THE TRACHEA

In 12 cases of well differentiated thyroid carcinoma infiltrating into the larynx and trachea, one total laryngectomy and 11 partial resections of the thyroid were performed. Anterior cervical tumor was the most common compliant. The half of the cases had symptoms such as dyspnea and hoarseness indicating infiltration into the larynx, trachea and recurrent nerve. CT scan and tracheal endoscopy were useful for cases in which the tumor invaded the tracheal mucosa, but for the other cases it was difficult to diagnose the tracheal invasion before operation. In the one case undergone laryngectomy, 3 circular resection and 8 luminar resection, the tumor was found to invade the mucosa in 3, circular ligamentum in 3, and external ligamentum in 3. Other 3 cases had no pathological invasion. Their prognoses are favorable that all the patients are still alive with no local recurrence. Resection of the thyroid carcinoma with the larynx and the trachea are considered to be useful to control the local area.

Circular resection of the trachea for strictures and tumours.

Nine cases of tracheal resections, of which 3 were for malignant tumours and 6 for stenoses, are discussed. All 9 cases were treated in the Department of Thoracic Surgery, Odense City and County Hospital during the period 1962-1969. Resection of the carina in connection with operations for lung cancer are not included in this material. One of the patients with stenosis had worn a tracheostomy tube for 16 years. The 6 stenoses and 1 tumour localised to the cervical and upper mediastinal trachea were resected by cervical incision with or without sternal split, while 2 widespread tumours in the mediastinal trachea were resected, followed by construction of a thoraco-tracheostomy in 1 case, and by reconstruction of the carina during extracorporal circulation in the other. One of the patients with a tumour of the planocellular type died 14 months after operation from recurrence and metastasis. The 2 other patients operated on for a cylindroma are well after 2 and 21/2 years' observation. One of the patients, w...

Surgery of tumours in the thoracic portion of the trachea.

We have operated on nine patients suffering from benign or malignant tumours in the thoracic portion of the trachea. The main clinical symptom was difficulty in breathing, accompanied in the majority of cases by attacks of asphyxia, cough with mucous phlegm, and haemoptysis. The following operations were performed: circular resection of the trachea with end-to-end anastomosis, thoracic tracheotomy with enucleation of the tumour, fenestral resection with auto-alloplasty of the ensuing defect, piecemeal removal of the tumour through the lumen of the trachea, and intrathoracic tracheotomy with biopsy of the tumour. All patients were discharged after the operation. When giving an anaesthetic during an operation on the thoracic portion of the trachea it is expedient to introduce a tube into the left main bronchus from the right pleural cavity and to exclude the right lung from ventilation. These measures ensure convenience of manipulation of the trachea, unhampered by the presence of a tube. End-to-end anastomosis is the best way to restore the thoracic portion of the trachea after circular resection. The problem of replacing large fenestral defects of the trachea can be solved by auto-alloplasty with thick Marlex, preliminarily overgrown with connective tissue.

Circular Resection and Suture of the Axillary Artery for Transverse Laceration by Fracture dislocation of Anatomical Neck of the Humerus

Circular Resection and Suture of the Axillary Artery for Transverse Laceration by Fracture dislocation of Anatomical Neck of the Humerus